Regulation and financing of prenatal screening and diagnostic tests for fetal anomalies in Europe

Abstract Background Pregnant women frequently use prenatal screening and diagnostic tests to detect fetal structural and chromosomal anomalies; however, the regulation and financing of these examinations differ substantially across countries. In this paper we focus on the provision, financing and setting of the following tests in selected European countries: First Trimester Screening (FTS)/Combined Test (CT), Non-invasive Prenatal Test (NIPT), second-trimester ultrasound screening for fetal anomalies, amniocentesis/chorionic villus sampling. Methods We chose 6 European countries that differ in various criteria (e.g., health/insurance system, geographical location) to illustrate the range of possible regulations and forms of funding: Germany, Switzerland, Netherlands, United Kingdom, Norway, Italy. We conducted a comprehensive hand search and consulted experts from the 6 countries using a questionnaire. Results The results are based on 11 completed expert questionnaires and 22 published sources. The heterogeneity of the provision, regulation and financing of the tests concerns in particular the choice of the first-line screening test for fetal trisomies (FTS/CT, NIPT or the identification of risk factors), the implementation of the NIPT, the reimbursement of the tests, the uptake of the examinations, but also the professional groups responsible for antenatal care (midwives, gynaecologists). There are some similarities between countries, e.g., concerning the provision and financing of invasive tests and of the ultrasound screening for fetal anomalies in the second trimester. Conclusions The results highlight the significant heterogeneity between European countries regarding prenatal screening and diagnostic testing for fetal anomalies. Due to the many ethical aspects of the topic, a broad societal discourse with the relevant interest groups and stakeholders seems to be necessary. Decision-makers should pay particular attention to high-quality and non-directive counselling. Key messages European countries take different approaches to offer and fund prenatal screening and diagnostic tests for fetal anomalies. The implementation of screening strategies should focus in particular on the importance of high-quality counselling to enable informed decision-making.


Background:
Maternal Respectful Care (MRC) approach was recommended by the WHO for improving maternal birth experience and mental health. We examined the association between MRC and Post-Traumatic Stress Disorder (PTSD) among postpartum women.

Methods:
A cross-sectional study took place between November 2020 and October 2021. 817 postpartum women (Jewish-444 Arab-373) were interviewed via Zoom due to Covid-19 limitations. MRC was measured by 26 statements from disrespectful/ abusive care during childbirth in facilities (DACF); 4 statements from the Mother on Respect questionnaire (MOR-feeling mistreatment based on ethno-national background, level of command of the Hebrew language and disagreement with the staff); and 4 statements regarding abuse of the NorVold Abuse Questionnaire (NorAQ). PTSD was measured by Solomon et al.'s tool, and dichotomized into 12 score cutoff. (Yes /No PTSD). Results: PTSD prevalence was 14.3%, significantly higher among Palestinian-Arab compared to Jewish women (22.0%,7.9%, respectively), and it was higher in women who had lower MRC scores: did not receive postpartum education (19.9%,11.9 % respectively) received; received midwife support 11.7%,18.4% didn't receive; reported racism 26.1%,11.4% not; Felt humiliated at healthcare services vs. not (16.8% , 10.6%, respectively); women who reported mistreatment based on national/cultural background, compared to others (MOR) (36.6%,13.1%, respectively). In the multivariate analysis after adjusting to different independent variables, Palestinian-Arab women were 6.04 times at risk for PTSD (OR = 6.04,95% CI = 3.38-10.78),Women who reported racism are 2.14 times more likely to PTSD (OR = 2.14, 95% CI = 1.30-3.54). Women who reported feeling humiliated visiting the health care system are 2.08 times more likely to PTSD (OR = 2.08,95% CI = 1.23-3.52).

Conclusions:
MRC is an important factor for maternal PTSD among postpartum women and it should be considered specifically among minority women. Key messages: MRC can contribute to quality care, improving birthing mothers experience and reducing negative health outcomes such as PTSD, and it should be improved for women. The health care services need to run a program to overcome racism and reduce unrespectful care for postpartum women.

Methods:
We chose 6 European countries that differ in various criteria (e.g., health/insurance system, geographical location) to illustrate the range of possible regulations and forms of funding: Germany, Switzerland, Netherlands, United Kingdom, Norway, Italy. We conducted a comprehensive hand search and consulted experts from the 6 countries using a questionnaire.

Results:
The results are based on 11 completed expert questionnaires and 22 published sources. The heterogeneity of the provision, regulation and financing of the tests concerns in particular the choice of the first-line screening test for fetal trisomies (FTS/ CT, NIPT or the identification of risk factors), the implementation of the NIPT, the reimbursement of the tests, the uptake of the examinations, but also the professional groups responsible for antenatal care (midwives, gynaecologists). There are some similarities between countries, e.g., concerning the provision and financing of invasive tests and of the ultrasound screening for fetal anomalies in the second trimester.

Conclusions:
The results highlight the significant heterogeneity between European countries regarding prenatal screening and diagnostic testing for fetal anomalies. Due to the many ethical aspects of the topic, a broad societal discourse with the relevant interest groups and stakeholders seems to be necessary. Decision-makers should pay particular attention to highquality and non-directive counselling. Key messages: European countries take different approaches to offer and fund prenatal screening and diagnostic tests for fetal anomalies.
The implementation of screening strategies should focus in particular on the importance of high-quality counselling to enable informed decision-making. iii330 European Journal of Public Health, Volume 32 Supplement 3, 2022